Facility Evaluation Report

On 06/24/25, Licensing Program Manager (LPM) Ulysses Coronel and Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced case management – deficiency and met with Staff and explained the purpose of this visit. The purpose of this visit is to issue a deficiency observed on 06/06/25 and during today’s visit. On 06/06/25, Licensing Program Analyst (LPA) Regina Cloyd conducted a subsequent unannounced annual continuation and met with Staff. The facility is licensed to serve six (6) non-ambulatory residents, of which one may be bedridden. The facility has a hospice waiver approved for six residents. Bedrooms #1, #2, and #4 are approved for non-ambulatory or bedridden residents.

Regional Office record review of the Fire Inspection Request by the Torrance Fire Department on 04/16/2019 indicates that only bedrooms #1, #2, and #4 are approved for non-ambulatory/bedridden residents. On 06/06/25, record review of register of residents revealed two non-ambulatory residents (R3 and R5) in rooms #3 and #5. Record review of medical assessment revealed R3 and R5 as non-ambulatory.

Deficiencies are being cited based on record review in accordance with the California Code of Regulations, Title 22, see LIC809D. An immediate civil penalty of $500 is issued.

An exit interview was conducted, plans of correction developed, and a copy of this report and appeal rights was discussed and left with Caregiver Rita Melindawati .